Choose your preferred view mode

Please select whether you prefer to view the MDPI pages with a view tailored for mobile displays or to view the MDPI
pages in the normal scrollable desktop version. This selection will be stored into your cookies and used automatically
in next visits. You can also change the view style at any point from the main header when using the pages with your
mobile device.

Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach

Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by known geographic variables (e.g., county poverty), and partly by a model for latent area influences. In particular, a shared latent variable (common factor) approach is proposed to measure the impact of unobserved area influences on joint weight and diabetes status, with the latent variable being spatially structured to reflect geographic clustering in risk.
Full article

Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to

Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus.
Full article

This paper aims to provide direct and indirect evidence on setting up rules for applications of the empirical Bayes shrinkage (EBS), and offers cautionary remarks concerning its applicability. In epidemiology, there is still a lack of relevant criteria in the application of EBS.

This paper aims to provide direct and indirect evidence on setting up rules for applications of the empirical Bayes shrinkage (EBS), and offers cautionary remarks concerning its applicability. In epidemiology, there is still a lack of relevant criteria in the application of EBS. The bias of the shrinkage estimator is investigated in terms of the sums of errors, squared errors and absolute errors, for both total and individual groups. The study reveals that assessing the underlying exchangeability assumption is important for appropriate use of EBS. The performance of EBS is indicated by a ratio statistic f of the between-group and within-group mean variances. If there are significant differences between the sample means, EBS is likely to produce erratic and even misleading information.
Full article

Yucheng City is located in northwestern Shandong Province, China, and is situated on the Huang-Huai-Hai Plain, the largest alluvial plain in China. In this study, 86 surface soil samples were collected in Yucheng City and analyzed for cation exchange capacity (CEC), soil organic

Yucheng City is located in northwestern Shandong Province, China, and is situated on the Huang-Huai-Hai Plain, the largest alluvial plain in China. In this study, 86 surface soil samples were collected in Yucheng City and analyzed for cation exchange capacity (CEC), soil organic matter (SOM), pH, available phosphorus (avail. P), phosphorus (P), aluminum (Al), and iron (Fe). These soils were also analyzed for ‘total’ chromium (Cr), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), mercury (Hg), cadmium (Cd), and lead (Pb), together with 92 wheat samples and 37 corn samples. There was no obvious heavy metal contamination in the soil and irrigation water. But the long-term accumulation of heavy metals in soil has lead to an increase of Ni, As, Hg and Pb concentrations in some of wheat and corn samples and Cd in wheat samples. Because of the numerous sources of soil heavy metals and the lower level of heavy metal in irrigation water, there is no significant relation between soil heavy metal concentrations and irrigation water concentrations. Cr, Ni were mainly from the indigenous clay minerals according to multivariate analysis. Little contribution to soil heavy metal contents from agricultural fertilizer use was found and the local anomalies of As, Cd, Hg, Pb in wheat and corn grain are attributed to the interactive effects of irrigation and fertilizer used. Aerial Hg, however may also be the source of Hg for soil, wheat and corn.
Full article

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist’s skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient’s weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient’s weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject’s stage of change, and psychological support.
Full article

Recently, a population-based case-control study observed a 60% increased odds ratio (OR) for cutaneous squamous cell carcinoma (SCC) among women who had ever used oral contraceptives (OCs) compared with non users (95% confidence interval (CI) = 1.0–2.5). To further characterize the putative association between OC use and SCC risk, we conducted a nested case-control study using a large retrospective cohort of 111,521 Kaiser Permanente Northern California members. Multivariable conditional logistic regression was used to estimate ORs and CIs adjusting for known and hypothesized SCC risk factors. Pre-diagnostic OC use was associated with a statistically significant increased OR for SCC in univariate analysis (OR = 2.4, CI = 1.2–4.8), with borderline statistical significance in multivariable analysis (CI = 2.0, CI = 0.91–4.5). Given the high incidence of SCC in the general population and the prevalent use of OCs among women in the United States, there is a need for more large, carefully designed epidemiologic studies to determine whether the observed association between OC use and SCC can be replicated and to better understand the etiologic basis of an association if one exists.
Full article

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis,

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30−39.9) and severe (BMI ≥ 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could “lose weight” if they needed to, distanced themselves from the word obesity, and stigmatized those “fatter” than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being “at war” with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults.
Full article

In Switzerland a rapid increase in the total overweight population (BMI ≥ 25) from 30.3% to 37.3% and in the obese segment (BMI ≥ 30) from 5.4% to 8.1% was observed between 1992 and 2007. The objective of this study is to produce

In Switzerland a rapid increase in the total overweight population (BMI ≥ 25) from 30.3% to 37.3% and in the obese segment (BMI ≥ 30) from 5.4% to 8.1% was observed between 1992 and 2007. The objective of this study is to produce a projection until 2022 for the development of adult overweight and obesity in Switzerland based on four National Health Surveys conducted between 1992 and 2007. Based on the projection, these prevalence rates may be expected to stabilize until 2022 at the 2007 level. These results were compared with future projections estimated for France, UK, US and Australia using the same model.
Full article

We examine the relationship between hydrologic variability and the incidence of human disease associated with West Nile virus (WNV; family Flaviviridae, genus Flavivirus) infection (hereafter termed “human WN cases”) in Colorado from 2002 to 2007. We find that local hydrologic conditions,

We examine the relationship between hydrologic variability and the incidence of human disease associated with West Nile virus (WNV; family Flaviviridae, genus Flavivirus) infection (hereafter termed “human WN cases”) in Colorado from 2002 to 2007. We find that local hydrologic conditions, as simulated by the Mosaic hydrology model, are associated with differences in human WN cases. In Colorado’s eastern plains, wetter spring conditions and drier summer conditions predict human WN cases. In Colorado’s western mountains, drier spring and summer conditions weakly predict human WN cases. These findings support two working hypotheses: (1) wet spring conditions increase the abundance of Culex tarsalis vectors in the plains, and (2) dry summer conditions, and respondent irrigational practices during such droughts, favor Cx. pipiens and Cx. tarsalis abundance throughout Colorado. Both of these processes potentially increase the local vector-to-host ratio, favoring WNV amplification among competent avian hosts and bridging to humans.
Full article

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one

This study explored the associations between health awareness, health behaviour, subjective health status, and satisfaction of students with their educational experience as independent variables and three outcomes of educational achievement as dependent variables. We undertook two simultaneous cross-sectional surveys among students from one University in the UK during 2008−2009. The first survey was a general health survey; the second survey measured students’ satisfaction with different aspects of their learning and teaching experience. Students’ registration numbers linked the responses of both questionnaires together, and subsequently linked the questionnaires to the university database to import the grades that students actually achieved in their studies. Generally, students (N = 380) exhibited average medium to high satisfaction with their educational experiences. Students’ satisfaction with their educational experiences was not associated with any of the three indicators of educational achievement (actual module mark; perceived own performance; importance of achieving good grades). The associations of educational satisfaction, health, health behaviours, heath complaints and financial parameters with the three outcomes of educational achievement did not differ between male and female students. Each of the health, health behaviours, health complaints and financial parameters were selectively associated with only some but not all three indicators of student educational achievement. We conclude that the findings support a conceptual framework suggesting reciprocal relationships between health, health behaviour and educational achievement. Comprehensive health promotion programmes may have the potential to influence relevant predictors of educational achievement in university students.
Full article

This paper reports the findings of a qualitative study investigating the impacts of renting a home on the psychosocial health of tenants in the Accra Metropolitan Area (AMA) in Ghana. In-depth interviews (n = 33) were conducted with private renters in Adabraka, Accra.

This paper reports the findings of a qualitative study investigating the impacts of renting a home on the psychosocial health of tenants in the Accra Metropolitan Area (AMA) in Ghana. In-depth interviews (n = 33) were conducted with private renters in Adabraka, Accra. The findings show that private renters in the AMA face serious problems in finding appropriate and affordable rental units, as well as a persistent threat of eviction by homeowners. These challenges tend to predispose renters to psychosocial distress and diminishing ontological security. Findings are relevant to a range of pluralistic policy options that emphasize both formal and informal housing provision, together with the reorganization and decentralization of the Rent Control Board to the district level to facilitate easy access by the citizenry.
Full article

South East Queensland is one of the fastest growing regions in Australia with a correspondingly rapid increase in sewage production. In response, local councils are investing in more effective and sustainable options for the treatment and reuse of domestic and industrial effluents. A

South East Queensland is one of the fastest growing regions in Australia with a correspondingly rapid increase in sewage production. In response, local councils are investing in more effective and sustainable options for the treatment and reuse of domestic and industrial effluents. A novel, evaporative solar dryer system has been installed on the Sunshine Coast to convert sewage sludge into a drier, usable form of biosolids through solar radiation exposure resulting in decreased moisture concentration and pathogen reduction. Solar-dried biosolids were analyzed for selected pathogenic microbial, metal and organic contaminants at the end of different drying cycles in a collaborative study conducted with the Regional Council. Although fecal coliforms were found to be present, enteroviruses, parasites, E. coli, and Salmonella sp. were not detected in the final product. However, elevated levels of zinc and copper were still present which restricted public use of the biosolids. Dilution of the dried biosolids with green waste as well as composting of the biosolids is likely to lead to the production of an environmentally safe, Class A end-product.
Full article

This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception

This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception (as “too thin”, “just right” or “too fat”), and the association of related factors with body image perception (nutrition behaviour, social support, perceived stressors and quality of life). The proportions of students who perceived themselves as “too thin”, “just right”, or “too fat” were 8.6%, 37.7%, and 53.7% respectively. Multi-factorial logistic regression analysis showed that students who perceived themselves as “too fat” were more likely to be from the British university, to be females, to be older than 30 years, to report stress due to their financial situation and were less likely to have a high quality of life.The findings highlight the need for interventions with focus on healthy food choices whilst acknowledging financial stressors and quality of life.
Full article

Text and structural data mining of web and social media (WSM) provides a novel disease surveillance resource and can identify online communities for targeted public health communications (PHC) to assure wide dissemination of pertinent information. WSM that mention influenza are harvested over a

Text and structural data mining of web and social media (WSM) provides a novel disease surveillance resource and can identify online communities for targeted public health communications (PHC) to assure wide dissemination of pertinent information. WSM that mention influenza are harvested over a 24-week period, 5 October 2008 to 21 March 2009. Link analysis reveals communities for targeted PHC. Text mining is shown to identify trends in flu posts that correlate to real-world influenza-like illness patient report data. We also bring to bear a graph-based data mining technique to detect anomalies among flu blogs connected by publisher type, links, and user-tags.
Full article

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours.
Full article

Human papillomavirus (HPV) is often transmitted through sexual partnerships. However, many previous HPV transmission models ignore the existence of partnerships by implicitly assuming that each new sexual contact is made with a different person. Here, we develop a simplified pair model—based on the

Human papillomavirus (HPV) is often transmitted through sexual partnerships. However, many previous HPV transmission models ignore the existence of partnerships by implicitly assuming that each new sexual contact is made with a different person. Here, we develop a simplified pair model—based on the example of HPV—that explicitly includes sexual partnership formation and dissolution. We show that not including partnerships can potentially result in biased projections of HPV prevalence. However, if transmission rates are calibrated to match empirical pre-vaccine HPV prevalence, the projected prevalence under a vaccination program does not vary significantly, regardless of whether partnerships are included.
Full article

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information.
Full article

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes. Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies. With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care. The long term intellectual outcome of children born to ethanol dependent mothers is influenced to a large extent by the environment in which the exposed child is raised.
Full article

Social factors have a tremendous influence on instances of heavy drinking and in turn impact public health. However, it is extremely difficult to assess whether this influence is only a cultural phenomenon or has biological underpinnings. Research in non-human primates demonstrates that the

Social factors have a tremendous influence on instances of heavy drinking and in turn impact public health. However, it is extremely difficult to assess whether this influence is only a cultural phenomenon or has biological underpinnings. Research in non-human primates demonstrates that the way individuals are brought up during early development affects their future predisposition for heavy drinking, and research in rats demonstrates that social isolation, crowding or low social ranking can lead to increased alcohol intake, while social defeat can decrease drinking. Neurotransmitter mechanisms contributing to these effects (i.e., serotonin, GABA, dopamine) have begun to be elucidated. However, these studies do not exclude the possibility that social effects on drinking occur through generalized stress responses to negative social environments. Alcohol intake can also be elevated in positive social situations, for example, in rats following an interaction with an intoxicated peer. Recent studies have also begun to adapt a new rodent species, the prairie vole, to study the role of social environment in alcohol drinking. Prairie voles demonstrate a high degree of social affiliation between individuals, and many of the neurochemical mechanisms involved in regulation of these social behaviors (for example, dopamine, central vasopressin and the corticotropin releasing factor system) are also known to be involved in regulation of alcohol intake. Naltrexone, an opioid receptor antagonist approved as a pharmacotherapy for alcoholic patients, has recently been shown to decrease both partner preference and alcohol preference in voles. These findings strongly suggest that mechanisms by which social factors influence drinking have biological roots, and can be studied using rapidly developing new animal models.
Full article

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change.
Full article

The epidemiological transition model describes the changing relationship between humans and their diseases. The first transition occurred with the shift to agriculture about 10,000 YBP, resulting in a pattern of infectious and nutritional diseases still evident today. In the last two centuries, some

The epidemiological transition model describes the changing relationship between humans and their diseases. The first transition occurred with the shift to agriculture about 10,000 YBP, resulting in a pattern of infectious and nutritional diseases still evident today. In the last two centuries, some populations have undergone a second transition, characterized by a decline in infectious disease and rise in degenerative disease. We are now in the throes of a third epidemiological transition, in which a resurgence of familiar infections is accompanied by an array of novel diseases, all of which have the potential to spread rapidly due to globalization.
Full article